ROAD SENSE: ARE YOU FIT TO DRIVE ON THE OTP?
How can drug use affect my driving?
It’s easy to forget how complex the task of driving is. Driving requires many skills - constantly checking the road and traffic conditions and making decisions. Driving involves sensing, knowing, and doing. It is important to clearly understand what is going on around us and then respond.
Driving is a complicated task, and along with sensing, knowing and doing there are other things that affect your driving. Below is a summary of some other things that can also impact on your driving:
Driving experience: Your current driving experience can play a large role in driving safety. However, even with many years of experience behind the wheel you still need to play it safe. Regardless of who is at fault, even the most experienced of drivers can be in an accident.
Weather: Driving on a warm sunny day is a lot different to a cold morning with fog or snow, or an afternoon with heavy rain that affects your ability to see the road in front. Considering the weather and how it will impact on your driving is critical to driving safety. Play it safe and reduce your speed or pull over for a break if needed.
Time of day: Driving at night or in the direction of the sun can pose a risk to your safety if not adequately managed. Slow down or take a break if tired, particularly if you find you are struggling to see in front of your vehicle.
Road conditions: Road conditions can unexpectedly change. You should always be vigilant and safe while driving, regardless of the road being highway grade or a local road. Consider the impact of things such as debris, accidents, emergency vehicles, pedestrians and other vehicles on the road.
Speeding: Not only is speeding illegal, which could lead to a fine, loss of points or loss of your licence, but it can also have an impact on your ability to control a vehicle and respond appropriately. Everyone has a responsibility to drive safely and within the designated speed limits.
Erratic driving: You should refrain from driving erratically, which can result in the police pulling you over if caught. Driving erratically not only puts your safety at risk, but the risk of others on the road and any nearby pedestrians.
Illness or injury: Talk to your doctor about your current illnesses and injuries as they are well placed to give you advice about your ability to drive.
Lack of sleep: Driving 17 hours without sleep is the equivalent of driving with a blood alcohol level of 0.05% (the equivalent of two standard drinks in the first hour for males and one standard drink for females). Generally, people are very bad at knowing whether lack of sleep is effecting their driving and whether they are too drowsy to drive.
Mood and Emotions: Your mood or frame of mind can have a bit impact on your driving ability. If you are feeling angry, depressed, or stressed it is important to recognise that these emotions can alter your ability to drive.
Medications: Be particularly mindful of sedating medications, such as benzodiazepines (like Xanax® or Valium®), and if you are taking multiple medications at the same time. Some medications can also have a greater impact on you when taken with alcohol or illicit substances. Talk to your doctor or pharmacist about how your medications may impact your driving ability. If you ever feel sedating from a medication, play it safe and do not drive.
Alcohol: You should not be driving if you consume alcohol while on methadone or buprenorphine. Not only that, but if you have had a few drinks you would most likely be over the legal blood alcohol limit and should not be driving anyway.
Illicit substances: It is important to remember that it is illegal to drive if you are under the influence of any drug. Be mindful that the illicit substance or its metabolites may still be in your system long after consuming the substance and this could come up in a Mobile Drug Test (MDT) or blood test. The safest thing for yourself and others is not to drive if you intend to consume an illicit substance.
How does my methadone or buprenorphine medication affect my driving?
There is good evidence that driving or operating heavy machinery after dosing with methadone or buprenorphine does not increase your risk of accident or injury. However, this doesn’t mean you will always be ok to drive. You should be on a stable dose of methadone or buprenorphine before driving. Also consider that a range of medications and drugs (especially alcohol, benzodiazepines, and cannabis) can affect your driving.
For example, if you are more sedated than usual from lack of sleep or using alcohol or other drugs, you can be less attentive and run the risk of a “micro-sleep” (or “nod”). If you have missed a dose and are in withdrawal your muscles can be jerky and less powerful, or you might be teary and sneezy which could affect your sight. Co-ordination, judgement and reaction time can all be affected.
You are more likely to be affected in the first weeks after starting your medication, when you are going up or down on your dose, if you miss doses or take more than your prescribed dose. The first four weeks of starting methadone and the first two weeks of starting buprenorphine are especially high-risk periods where you should avoid driving.
During these higher-risk time, you should seek alternative transport instead of driving. Depending on your circumstances, you may want to think about;
Walking or riding a bike
Catching public transport
Asking a friend or family member to give you a lift
Talking to clinic staff to see if they can help arrange transport
Putting a note up in your clinic to see if anyone is willing to carpool
Contacting a charity, church group, or community group like Rotary or Men’s Shed to see if they are able to help arrange transport.
Can other medications or drugs combine to affect my driving?
Driving can be far less safe if you also use other drugs or alcohol on top of your dose. Adding in prescription medications, such as other opioids, ‘benzos’, anti-epileptics, anti-depressants, anti-psychotics, and/or pregabalin (known as Lyrica®, and given for nerve pain, anxiety and epilepsy) can really make a difference to how well you drive.
You should talk to your doctor or pharmacist if the medications you are taking can increase your fatigue, make you more sleepy, or can impact on your driving ability. Do not assume that you are safe to drive.
Are there other safety factors to think about?
There are many things you need to think about to make sure you are safe to drive. Even when you are on a steady dose and aren’t using other drugs or alcohol, being tired, emotional or sick will affect how you drive. It’s important to know when you are safe and when you are not.
It’s also vital you keep your car in good condition, checking brakes, mirrors, headlights, blinkers and so on to make sure your car works properly and safely.
How can I know if I am safe to drive?
Ask your doctor or pharmacist, who can give you advice about whether or not it is safe for you to drive. Check the label on your medications, as some can affect how you drive. If a drug is prescribed to you and you are taking it exactly as advised, you will know how to manage the risks.
You should also use your common sense. People often know when they shouldn’t be driving.
You should not drive when under the influence of illicit drugs, even if you use them daily. There are simply too many things that can change the way the drug might effect you.
Are there rules about when I can’t drive if I am on a methadone or buprenorphine program?
You are ok to drive if you are stable on your dose and are not affected by significant amounts of other medications or drugs. Driving gets safer when your body and brain get used to taking the same dose for methadone or buprenorphine over a long period of time. You should not drive for several days following any dose change.
Missing or increasing your dose, as well as changing your route of administration (like injecting it), may impact your ability to drive safely.
The NSW Clinical Guidelines: Treatment of Opioid Dependence (2018) recommends not driving 4 weeks after you begin a methadone program and being especially careful for 3-5 days if you change your dose by 5 mg or more. With buprenorphine you should not drive for 2 weeks after you begin a program and being especially careful for 3-5 days after a change of dose.
Methadone (Biodone Forte® or Methadone Syrup®)
Do not drive: 4 weeks from start
Especially Careful : 3-5 days after dose change
Buprenorphine (Suboxone® or Subutex®)
Do not drive: 2 weeks from start
Be especially careful: 3-5 days after dose change
How do I get guidance about when I should drive?
One of the responsibilities of your healthcare providers (including pharmacists, clinic nurses, case workers, peer workers and doctors) is to help ensure your safety while taking medication. This includes advising you about driving safely.
The best thing you can do is to talk honestly with your doctors about your fitness to drive. You should make them aware of all your current stresses and challenges and all the medications you are taking, especially if your doctor didn’t prescribe them.
Then you should ask them to explain the effects those drugs may have on your ability to drive and offer some advice about when you should or shouldn’t be driving. You can also ask your pharmacist, clinic nurse, or peer worker, as they will be able to give you advice as well. Don’t forget you can even contact the Opioid Treatment Line (OTL) or the NSW Users and AIDS Association (NUAA) to give you advice.
You should also talk in a general way about how illicit drugs and/or alcohol might add to the mix in your case.
Can I get a card from the doctor to give police to say I am on a program?
There is no need for a card. You do not have to tell police you are on a program and Mobile Drug Tests do not test for opioids.
Why is it my responsibility to know when I am fit to drive?
It is your responsibility to be able to recognise when you may not be fit to drive. Your safety and the safety of others depends on it.
Many medications that cause sedation or drowsiness are required to have labels by the Therapeutic Goods Administration (TGA). The TGA is part of the Commonwealth Department of Health and its role is to keep Australians safe through regulating medications. You may notice that methadone and buprenorphine carry a label stating the following:
If you get takeaways you would have seen this label on your medication bottles or packs. This labelling means that it is your responsibility to think about how the medication affects you, to not mix it with alcohol, and not to drive if you are feeling drowsy. Other medications that you are prescribed may also have similar labels like below as well:
There are many other medications that can also affect your driving, including some over-the-counter medications such as cold and flu tablets. Be sure to follow the advice on the label or product information sheet inside, speak to your doctor about the medications you are currently taking, and speak to your pharmacist for more information or if you are unsure about anything.
Different people are affected differently – gender, body size, and general health can all play a part in how quickly a person processes drugs or how much they are affected by different drugs. It comes back to you as an individual to understand or seek information from healthcare providers if you are unsure.
It is important to be able to recognise when you may not be fit to drive. Your safety and the safety of others depends on it.
What if I ignore my doctor’s advice about driving? Are there legal implications?
Your healthcare provider has a responsibility to your safety and to the safety of the community. So, if you ignore their advice to stop driving, they may have to report you to the Roads and Maritime Service (RMS). The RMS will then assess whether you require additional driving aids to assist your medical condition (such as hand-operated breaking) to drive safely or whether a conditional licence is appropriate. In some cases, you may need to stop driving completely. These decisions are made by the RMS with input from your doctor and other healthcare providers.
It is also important to recognise that if you have a medical condition that impacts your ability to drive safely long-term you also have an obligation to inform RMS. Such medical conditions can include: epilepsy, seizures, diabetes, heart disease, dementia, and sleep disorders, among others.
If you attend treatment while intoxicated and intend to drive, the clinic nurses, doctors, and/or pharmacists also have a duty of care to ensure your safety and the safety of the community. Ensuring your safety may include contacting the police. It will also result in either a reduced dose, your dose being withheld, or being asked to return later in the day.
When can I be tested for Mobile Drug Testing (MDT)?
NSW Police can test drivers for drugs anytime or anywhere for no reason at all. MDT is random.
However, there are other reasons the Police might pull you over, including:
something about you or your vehicle makes a mobile police officer suspicious of you
a police officer knows you as a person who uses drugs
you are driving oddly or dangerously
you are in an accident.
See the NSW Government Transport for NSW https://www.transport.nsw.gov.au)page for more information on MDT.
What drugs are tested in Mobile Drug Testing (MDT)?
By using saliva sticks, MDT tests for:
methamphetamine (including speed and ice).
Roadside drug tests do not test for opioids or opioid treatment.
Will drug use only show up on a Mobile Drug Test (MDT) if I’m stoned?
MDT does not test for drug impairment. It tests for the presence of drugs. The test may come up positive for drugs, even several days after using them. It’s hard to know how many days after using you might test positive. Drugs stay in people’s bodies for different lengths of time, depending on things like gender, weight and general health. Drugs also tend to stay longer in people’s bodies if they are living with kidney disease, liver disease or cirrhosis of the liver.
A one-off use of a drug will pass through your body more quickly than if you have used for several days in a row. When thinking about how long drugs stay in your body, consider that small amounts may remain within your system for more than a week.
What do I have to tell the police if I am stopped for a Mobile Drug Test (MDT)?
Remember: you do not have to tell police anything except your name, date of birth and address as well as showing your driver’s licence. If they ask you about your recent or habitual drug use, you do not have to tell them anything, even if the MDT comes up positive.
You also do not have to tell Police you are on a treatment program.
The best advice is to be polite and courteous and say as little as possible.
Passengers in the vehicle are not subject to MDT unless: 1) the passenger is supervising a learner driver, or 2) if the police reasonably believe the person was driving the vehicle, such as witnessing the drivers changing seats prior to approaching police. Additionally, passengers are under no obligation to tell the police about the driver’s drug use or if the driver is on a treatment program.
What happens if a roadside drug test is positive?
If your MDT test is positive, you’ll be taken to a roadside testing van or bus, or back to a police station to provide a saliva sample. This sample will also be tested and, if positive, you’ll be banned from driving for 24 hours. All samples are sent to a laboratory for analysis. If the laboratory confirms the positive roadside result, police will contact you and charge you with driving with the presence of an illegal drug. You might lose your licence for a period of time and be required to pay a fine.
If you test positive for illicit drugs and have been driving erratically, you may be charged with driving under the influence (DUI). This charge is a more serious and you could lose your licence for a longer period of time and be required to pay a larger fine.
If you test positive for prescription drugs, you might be charged with DUI if you are driving dangerously.
Remember that if you drive with the presence of an illegal drug, your insurance and registration are null and void. This could have significant financial repercussions if you have an accident.
What happens if a driver is pulled over and they are affected by an illicit drug or a medical treatment?
It is important to remember that it is illegal to drive if you are under the influence of any drug.
If a Police officer has a reasonable belief that a driver is under the influence of a drug, based on how the person is driving, their condition or their behaviour and they pass a roadside breath test, the officer can require the driver to complete a sobriety assessment.
If the driver fails or refuses the assessment, the Police officer can arrest them and require them to undergo blood and urine testing. The tests can identify a wide range of illegal drugs and medication, including opioids and opioid treatment and the concentration in the blood. This can show whether a treatment has been taken in a therapeutic dose as prescribed, and whether other drugs are present.
The results, along with police observations at the roadside, can be used as the basis for charging a driver with the offence of driving under the influence of a drug. This is a serious offence with heavy penalties including fine and loss of licence.
What happens if a driver who is taking an opioid replacement treatment is involved in a fatal crash?
In NSW, all drivers who are involved in fatal crashes, or serious crashes where a person may die, can be taken for mandatory blood and urine tests. The tests can identify a wide range of illegal drugs and medication, including opioids and opioid treatment and the concentration in the blood. This can show whether a treatment has been taken in a therapeutic dose as prescribed, and whether other drugs are present.
All fatal crashes are investigated by NSW Police, and the results of the tests may be taken into account if a driver is charged with an offence.
Remember that if you drive with the presence of an illegal drug in your system, your insurance and registration are not valid. This could have significant financial repercussions if you have an accident – for example you may be responsible for paying for any damage you cause.
Can the police search my car or undertake a person search if my Mobile Drug Test (MDT) comes back positive?
A police officer can search a person if they have reasonable grounds to suspect that the person has a prohibited drug in their possession. They can also search a vehicle if they have reasonable grounds to suspect that it contains a prohibited drug, or that one of the passengers has a prohibited drug in their possession or control.
A positive drug test may constitute reasonable grounds to conduct a search of a person, their belongings and their vehicle. However, police can only ask the person to remove outer layers of clothing, hats or footwear. The police cannot conduct a strip search in a place other than a police station unless the seriousness and urgency of the circumstances makes the search necessary.
Police also have additional powers to search persons upon or after arrest. As noted above, police may arrest a person who refuses a drug test or whose sample tests positive. Police may search a person at the time or after their arrest if they suspect on reasonable grounds that it is prudent to do so in order to determine whether the person is carrying a prohibited drug, drug-related items or any other objects that may be connected to an alleged crime or provide evidence of a crime having been committed.
Are there circumstances where a Mobile Drug Test (MDT) comes back negative but a person is sent off for a more complex drug test that checks for additional substances?
If a driver does submit an MDT and result comes back negative, the police do not have the power to force the driver to undergo further testing, such a blood and/or urine sample testing.
However, if you are unable to provide a sample or refuse to provide a sample the police can require you to provide blood for drug testing. Police can also require a driver or person sitting next to a learner driver to undergo blood and urine testing if the learner driver has been involved in a potentially fatal accident.
If I’m not safe to drive, how am I going to get around?
Explore the options and plan ahead to make sure you get from point A to point B in one piece.
Your family, friends and neighbours are good options for transport and are often happy to support you while you adjust to treatment, especially if you explain you are trying to keep everyone safe and make important changes to your life.
You could try asking people on the program who live near you if you could car pool. Put a sign up on the notice board at your clinic. If you have been on the program for a while, think about others who are new and maybe offer them a lift to and from the clinic. Have a chat to the staff at your clinic, such as the Nurse Unit Manager (NUM) or peer workers, for what might be available.
You might also ask your local Council, community groups or charities. For example, some charities or church groups have volunteers that might give you a lift to the clinic or help with things like health needs or shopping while you get stable on your dose. You won’t know if you don’t ask. If your clinic is at a hospital you may be able to take advantage of free buses that go from the hospital to the nearest train station.
Public transport is an option, depending on where you live. Check out what is available in your area. Trip Planner (https://transportnsw.info/trip)is a great web site for planning NSW travel.
There are times you might be more cashed up and can catch a taxi or a rideshare service (like Go Catch, Ola, or Uber), or even splitting the fare with someone. It can certainly be worth it to keep you, your family and your community safe, but admittedly for most of us it’s only a short-term option.
For some people it is possible to go low tech – walking, skateboarding, riding a bike, or even a horse! Just remember that riding a bike or horse on the open road is the same as driving in terms of being drug tested.
Do I have any other options so I can drive and still take care of my health needs?
Methadone is an opioid and depending on the amount you are prescribed, when you were last dosed and how long you have been on the program, you might feel sedated from time to time. People on buprenorphine tend to say they feel more alert. Because of this, the guidelines around methadone call for greater care and longer safety lead times than those that apply to buprenorphine. You can check out what the safety lead times are for these medications here.
If you prefer driving or need to drive to get around, it might be worth discussing with your prescriber about swapping over to buprenorphine. This can be particularly helpful if you need to balance the use of ‘benzos’, anti-depressants or other meds that have a sedating effect.
Where can I find out more information?
Try checking out these links:
Austroads Assessing Fitness to Drive, is aimed at health professionals to assist them in assessing their patient’s ability to drive
NSW Clinical Guidelines: Treatment of Opioid Dependence. There is a full version and an abbreviated version.